Sanders revs up ‘public option’ fight after Aetna leaves ObamaCare

[grahamhgreen]

http://thehill.com/policy/healthcare/291644-bernie-sanders-sees-new-life-in-public-option-fight

The senator said he will reintroduce his legislation to create a “Medicare-for-all” system in the next session of the Senate, “hopefully” after Democrats regain control of the chamber.
“In my view, the provision of healthcare cannot continue to be dependent upon the whims and market projections of large private insurance companies whose only goal is to make as much profit as possible,” Sanders said in a statement Tuesday. “That is why we need to join every other major country on earth and guarantee health care to all as a right, not a privilege,” he said.

Aetna announced late Monday it would pull out of ObamaCare exchanges in 11 states, including Arizona, Florida and Texas. The company’s CEO, Mark Bertolini, cited $200 million in losses over the past few months as a major reason for the move. The insurer’s high-profile departure is a major blow to the law. Still, longtime public option proponents believe they have a new opportunity to take aim at the healthcare law's heavy reliance on insurers for coverage.

Sanders, who battled Hillary Clinton in a close Democratic presidential primary before conceding last month, has long fought for a government-run insurance plan, which he says would wrest healthcare coverage out of the control of private insurers. In his statement Tuesday, Sanders slammed insurers like Aetna for pulling out of the exchanges “despite the Affordable Care Act bringing them millions more paying customers than ever before.”

“These companies are more concerned with making huge profits than ensuring access to healthcare for all Americans,” he said.

Liberal Democrats have been increasingly vocal about the need for a public option push next year, with growing hopes that Clinton will win the White House and Democrats will take back the Senate. Sanders is hoping to become chairman of the powerful Senate Health, Education, Labor and Pensions Committee, which would give him a high podium in a healthcare fight.

Still, the fight would be taxing for a Democratic Party that has painful memories about the ObamaCare battle in 2009 and 2010. The fight over the law — which passed without any Republicans — was a key factor in the GOP wave the 2010 election cycle, costing the Democrats their majority in the House.

Looking forward to Hillary's leadership on this important issue.

Can we be sure that she will support at least a public option and lowering Medicare eligibility to 55 as she has stated?

EDIT: from her recent speech - "I’ve also said I will defend and improve the Affordable Care Act, and for me, that includes giving Americans, in every state, a choice of a public option health insurance plan that will help everybody afford coverage, it will strengthen competition, and drive down costs."

[elleng]

1. Good.

[grahamhgreen]

2. I was unaware the law allowed insurers to withdraw from obamacare. Seems like a fatal flaw.

[elleng]

6. I agree,

but probably to 'assure' them of an 'open' marketplace. Might not enter without ability to withdraw.

[former9thward]

29. You can't force companies to lose money.

[HereSince1628]

40. But it seems you can force consumers to pay big mark-ups for health financing

that is demanded to meet over-pricing in products and services.

Until we wake up and realize that free-market pricing really doesn't work for much of the health services/products industry we will have crises in delivery of those services.

[Wednesdays]

42. But it's perfectly acceptable to force people off of health insurance

nt

[Hortensis]

46. That was and is the choice of the American people.

Go figure, but those who want profiteering in insurance have votes too, and there are actually MORE of them than there are who supported healthcare reform. One could say that both expansion of Medicare and the ACA are against the will of the American citizenry.

Of course, we know perfectly well that when they supposedly manage to get the ACA repealed they full expect to retain guaranteed coverage for all regardless of previous conditions and unlimited lifetime coverage for conditions. Without the huge premiums that would come with that.

Extremely stupid of them, but so are those who assume insurance companies are exhibiting pure greed when they decide to withdraw entirely from markets that just don't pay enough to cover those law-mandated coverages. We either need to get more Americans paying into the insurance pool to cover these things or we need to subsidize it further with our taxes.

Whether single-payer or free market, nothing is free. The bill for our healthcare is ours, and it will always be huge even after the American people decide to remove profiteering from healthcare.

[grahamhgreen]

53. They don't even exist unless we allow it. We can force them to do what we will.

BTW, "Net income (1) per share was $2.23 for the second quarter of 2016"

[former9thward]

61. Maybe in your world but not mine.

Mine has a U.S. Constitution which prevents the government from " We can force them to do what we will."

[George II]

37. Read their announcement and the law. They are not "withdrawing from the ACA".

[grahamhgreen]

55. Not true, allow me to quote them:

“While we are pleased with our overall results, in light of updated 2016 projections for our individual products and the significant structural challenges facing the public exchanges, we intend to withdraw all of our 2017 public exchange expansion plans, and are undertaking a complete evaluation of future participation in our current 15-state footprint,” said Bertolini.

[still_one]

49. I suspect most of this problem is due to states that were against the expanded Medicaid, and never

setup exchanges in their own states, along with an active campaign in those republican states encouraging people not to participate in the ACA.

The ACA, as Medicare needs everyone to sign-up to work effectively. That is why Medicare has a very strong incentive to sign up when one turns 65, and if they don't, there will be substantial lifetime premium penalties

All insurance programs balance those who are healthy verses those who are not. Since there are usually more healthy folks in the pool, their premiums offset the medical costs for those that are not as healthy.

For those people who are not covered by insurance by their employer or some other way, this subset of the populace is required to sign up for the ACA, or they may be subjected to a penalty. There are exceptions to this, such as if the premium costs exceed a person's income by a certain percentage, they are exempt from the penalty.

In addition, income levels and family size are taken into consideration where many can get reduced payments through subsidization.

A lot of eligible folks still haven't signed up for the ACA, and a lot of the red states refused to expand Medicaid. This has all contributed to the issues why some of these insurance companies are leaving those states where it isn't feasible, while at the same time they are remaining in other states where it is feasible.

While the ACA has issues, and some serious holes, if everyone of those states had been on board there would have been far less issues like this.

When you have young healthy people with the opinion that "I don't need insurance, and the government cannot force me", in large enough numbers, that effects the ACAs efficiency.

Another issue which the media likes to ignore, is that for any program such as the ACA, it takes years for it to get off the ground. As more people sign up, and get on board, the dynamics of the ACA will move into a more feasible solution.

If the Democrats are able to control Congress, and the Executive Branch, I would expect the ACA deficiencies addressed. I could even visualize where an option for

Medicare also isn't free, and depending on the level of coverage it can get quite expensive when you factor in supplemental policies, drug costs, and dental costs.

[grahamhgreen]

56. We need a public option, agreed?

[still_one]

60. A public option is more likely to occur before single payer, unless the political landscape changes

significantly. The public Option would essentially allow citizens and permanent residents to buy into something like the Medicare program.

People covered by other employer plans or by plans such as Medicare would not be eligible. In the public option, the plan would be financed entirely by premiums without subsidy from the Federal government.

A single payer type system is financed through taxes, and has no cost to the person seeking medical treatment. That I believe is unlikely to occur in the near term. That resembles true socialized medicine.

A public option also could take different forms. It could be setup to compete against private insurance plans, or take the form of allowing the public to buy into the public Medicare program.

The Democratic Platform Committee approved a plank supporting the addition of a public option onto the Affordable Care Act. In 2013 Jan Schakowsky and other Democrats in the House introduced a bill that would amend the ACA to create a public option. The bill would setup a government-run health insurance plan with premiums 5% to 7% lower premiums than private insurance.

One thing is essential for any public option plan, is that those who are not covered under another insurance plan, must be required to participate

To your question, "Do we need a public option?"

I would answer generally yes, but the details of that public option are critical

[awoke_in_2003]

67. If we start the fight

at Public Option we will not get it. We've been down that road, and were given a turd. If I want to sell you something, it is not wise to start the haggling at the price I want to sell it for.

[still_one]

68. All I am doing is trying to point out the differences between the public option verses

single payer

I am not "haggling" about anything, I am just stating the differences

[awoke_in_2003]

69. Yes, I mean to say

that dem leadership can not start the fight at PO if they want to get it. Our input, of course, means little. They are going to listen to the lobbyists first.

[still_one]

70. you are right, unfortunately on both points. Still it is important they hear our feedback

[awoke_in_2003]

71. If we make enough noise

maybe they will finally listen. Health care in this country is too damn costly, and far too many people are slipping through the cracks

[sheshe2]

3. Your comment is interesting.

Can we be sure that she will support at least a public option and lowering Medicare eligibility to 55 as she has stated?

[grahamhgreen]

4. Looking from some assurance from Hillary supporters, and then, by her.

[sheshe2]

10. First of all if all Dems...

are not going to show in droves to vote in November for our down ticket then nothing anyone has said has a snowballs chance in hell of happening.

Now:

Looking from some assurance from Hillary supporters, and then, by her.

You obviously are voicing your concerns, you seem very concerned. You need to start listening to what she is saying. I can't think for you. I can't speak for you. You need to make your own adult decisions. It is your voice, it is your vote. I will leave it at that.

[SunSeeker]

11. She has said she would. Hillary Clinton is one of America's most honest politicians.

http://www.democraticunderground.com/10028081207

[grahamhgreen]

17. Excellent! I look forward to reading her specific legislation!

[SunSeeker]

20. Good. Now get to work getting the vote out so we have a Dem House. nt

[Stubborn]

36. Then you don't agree with me.

I don't think they lean conservative.

[SunSeeker]

50. I agree that Politifact leans conservative. All the more reason that chart is impressive. nt

[SunSeeker]

66. Then why the "LOL"?

[George II]

38. And if you don't get such "assurance"?

[grahamhgreen]

48. I'm sure I will! It's a positive issue!

[KMOD]

5. Since she's been advocating for it since 2001

https://www.congress.gov/bill/107th-congress/senate-bill/623/cosponsors

Yeah, I think you can trust her to keep it up.

Didn't we just discuss this the other day?

[elleng]

7. 'Advocating' = 'co-sponsoring?'

[KMOD]

8. As opposed to doing nothing?

No one has done more for health care than Hillary Clinton. No one has accomplished more with regards to health care than Hillary Clinton.

Stop the hating, Ellen.

[elleng]

9. No, NOT as opposed to doing nothing.

Please stop accusing me of hating HRC, KMOD. As I've said, I've never hated her, and surely have not said I hate her.

She was not my favorite candidate. There is always room for improvement.

[KMOD]

12. Ellen, I love you, but your criticism of her has been off the wall.

and I take every member of JPR with a huge grain of salt.

Hillary on health care.

https://www.hillaryclinton.com/issues/health-care/

[elleng]

13. My 'criticism' of HRC has barely been apparent,

and I must take such criticism of me as sorely wanting. 'Love' me? You surely show it in odd ways, for example, not 'cognizant?' Please stop.

[KMOD]

15. Ellen, when you were posting rw blog shit,

it was quite apparent.

[LiberalLovinLug]

22. To some, maybe you

Anything remotely critical of her during the primaries, even if based in fact, was slammed as "right-wing blog shit".

[KMOD]

23. No, she actually posted right wing blog shit

and it was rightfully hidden.

The effin primary is over. DU has implemented new terms of service.

Constructive criticism is allowed, right wing source smears are not.

This isn't freaking rocket science.

[LiberalLovinLug]

24. That's right the primaries are over

I was going to remind you of this as you were the first to regurgitate it by dismissing a posters concerns based on some accusation of rule breaking which may or may not be true that supposedly happened during that time.

That was then, this is now. Many went over the line back then in the heat of the race including myself.

The primaries are over though so please take your own advice. Bernie and those that at one time campaigned for him are not the enemy anymore.

[KMOD]

25. Right.

So stop bending over backwards to try to bash our nominee.

[GreenPartyVoter]

34. +1

[elleng]

31. Malarkey!

NO rocket science, but civility appreciated. WHO exactly is not COGNIZANT?

[KMOD]

47. anyone who refuses to see

Trump's glaring sexism.

[elleng]

54. and I know no one who refuses to see tramps sexism,

among his other miserable characteristics.

[sheshe2]

16. To some maybe, not all. nt

[SunSeeker]

18. "barely been apparent"?

Wow.

[elleng]

32. Darn right.

Notice my role here: http://www.democraticunderground.com/?com=forum&id=1281

[SunSeeker]

51. Please don't make me dig up your past posts. The primary is over.

It is not worth it. Move on and support our nominee.

[think]

57. Good grief. /nt

[George II]

39. Maybe she was not your favorite candidate, but if you're a Democrat she now IS your candidate.

[sheshe2]

63. +1000!

[cali]

30. Please stop accusing people of hating. As MY idol said in Two Cheers for Democracy:

Democracy has another merit. It allows criticism, and if there
is not public criticism there are bound to be hushed-up scandals.
That is why I believe in the press, despite all its lies and vulgarity...



http://spichtinger.net/otexts/believe.html

OK. So he said it in 1938. It's still true even if the press is far worse now. And reasonable criticism of HRC shouldn't be shouted down. Attempts to shut people up by calling them haters is a tactic to shut people up.

It should be enough that those of us who opposed HRC for the Presidency- going back years- are voting for her in November, and are willing to work toward that end. That doesn't mean that my doubts and the doubts of others, are magically erased.

I know you don't want to face it, and want to call it all republican smears, but whatever the genesis, Hillary Clinton has a trust problem- AMONG DEMOCRATS- as well as among Republicans and Independence.

I want HRC to beat the tar out of DJT. I want her to succeed in the Presidency. And when she is elected, it is incumbent on her to win trust. That it's down to her is the bottom line.

I don't look for things to criticize HRC for. The primaries are over. To the contrary, I actively look for things that will increase my confidence in her stated priorities: I am really pleased that she's named Heather Boushey as the top economic advisor on her transition team, for example.

But I believe in criticism in the same way Forster did: It's an essential, critical piece of a functioning democracy. I realize that DU is a private site, but shouldn't it reflect and respect democratic traditions?

I say all this respectfully. And probably with too much hope. I get why passionate HRC supporters who have supported her for President for a long time, are defensive. I understand you think doubts about her are unjustified, that no criticism is best. And I don't think sniping at her about her commitment to this or that plank of her platform, is particularly "good" criticism, in that it doesn't offer any positive changes, but I do hope her most dedicated supporters can manage to deal with such mild criticism.

Democracy and criticism should continue to be closely linked. Lose the latter and you lose the former. I value DU because it's never been merely a "hive mind". I imagine you do too.

[George II]

41. Yes. And that bill is just one example of her advocacy over the last 25+ years.

[ConservativeDemocrat]

14. Finally, something Hillary absolutely CAN lead on...

For once, the far left of the Party is correct. Hillary can push for the Public Option - otherwise known as "Let people buy into Medicare at the government price".

The way how is as follows: use the bully pulpit of the Presidency to encourage state legislatures to offer the public option. The ACA right now has a provision put in by Senator Wyden (D-Oregon) that lets states get all the money if they can do better than the federal government. She just needs to give them a waver, which would be very easy to do.

This is the law right now. No new laws need to get past the GOP-held Congress.

- C.D. Proud Member of the Reality Based Community

[grahamhgreen]

19. Good news! Can she provide a waiver as President, or is it given by some other entity?

[ConservativeDemocrat]

21. Section 1332 would be negotiated by HHS, but ultimately the President signs off on it

By the way, single payer can also be implemented this way, if a State so chooses. In fact, in Colorado there is an initiative to do exactly that.

http://healthaffairs.org/blog/2014/12/05/section-1332-waivers-and-the-future-of-state-health-reform/

The Affordable Care Act (ACA) turbocharges state innovation through a number of provisions, such as the creation of the Center for Medicare & Medicaid Innovation, funding for states to establish customized insurance exchanges, and Medicaid reforms such as health homes and projects geared toward the dual eligible population. Yet another component of the law holds even more potential for broad reform. Buried in Section 1332 of the law is a sparkplug for innovation called the State Innovation Waivers program.

Also known as 2017 waivers or Wyden waivers, 1332s offer wide latitude to states for transforming their health insurance and health care delivery systems. According to the statute, states can request that the federal government waive basically every major coverage component of the ACA, including exchanges, benefit packages, and the individual and employer mandates. But the cornerstone of 1332 waivers is the financing. To fund their reforms, states can receive the aggregate amount of subsidies—including premium tax credits, cost-sharing reductions, and small business tax credits—that would have otherwise gone to the state’s residents. Depending on the size of the state, the annual payment from the federal government for alternate coverage reform could reach into the hundreds of millions or even billions of dollars.

A better name for this program might be Waivers for State Responsibility, because they don’t exempt states from accomplishing the aims of the ACA, but give them the ability (and responsibility) to fulfill the aims in a different manner while staying between certain guardrails. State reforms must ensure “affordability,” cover a “comparable” number of people as statutory ACA implementation would have, and not increase the federal deficit.

- C.D. Proud Member of the Reality Based Community

[pnwmom]

26. Yup. The ACA gave the insurers a chance to show they could manage this. If they can't,

then it's time for Medicare for all or another public option.

[white_wolf]

27. It's starting to look like they can't.

Not that I'm surprised. The private health insurance industry are little more than vultures.

[grahamhgreen]

58. Apparently, they can't!

[flor-de-jasmim]

28. $200 million in losses...out of how much in profits??

[mythology]

33. On the ACA members, none

The people who signed up for insurance under the ACA individual market were for sicker than expected, particularly in prescription drugs which aren't included in the risk management system set up as part of the ACA.

[Loki]

44. Try "billions".

[seaglass]

45. This is all about the DOJ refusing the Aetna-Humana merger.

http://www.motherjones.com/kevin-drum/2016/08/memo-aetna-pulled-back-obamacare-because-doj-opposed-merger-humana

Well, they were losing money. But in a letter to the Department of Justice last month, they made a pretty explicit threat: they would have "no choice" but to cut back their Obamacare participation if they were unable to take advantage of the "synergies" of the merger:

[grahamhgreen]

59. 791 million, I believe.

[Adrahil]

35. Good. We need a public option. NT

[Loki]

43. Trust me,

As someone who was on the provider side for almost 30 years, these insurance companies are not hurting, they just don't get to screw the consumer and the provider as much anymore. So instead of profits in the triple digits they lose about 1%. I don't feel the least bit sorry for them.

[auntpurl]

64. Good. I'm in favor of a public option (though not single payer)

and Hillary is too. This is something she can tackle right away.

However, we have to get her elected first. I was hoping Bernie would be a stronger ally on the stump. So far, I haven't seen much of him. Maybe she's holding him in reserve until the post-Labor Day push.

[Initech]

65. Go Bernie! These billion dollar corporations don't give a shit about us or health.

They only care about one thing: profit.

[TransitJohn]

72. If we have to buy it under penalty of law,

shouldn't they have to sell it?